Chapter 4
What would the instructor tell her students is the average daily fluid intake for an adult?
2000 mL
A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be?
275-300 mOsm/kg
What should the nurse estimate a normal serum osmolality to be?
275-300 mOsm/kg
A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of what?
280 mOsm/kg
Which electrolyte is a major anion in body fluid?
chloride
What intravenous solution would be the safest for a patient with hypernatremia in need of fluid volume replacement?
0.45% sodium chloride
Which is considered an isotonic solution?
0.9% normal saline
A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client?
165 mEq/L
The average daily fluid intake for an adult is what?
2000 mL
What is a complication of SIADH?
cerebral edema
Which could be a potential cause of respiratory acidosis?
hypoventilation
One of the best indicators of the patient's renal function?
serum creatine 0.6-1.2
To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?
tachycardia
Hyperchloremia S/S
tachypneic, lethargy, weakness, diminished cognitive ability, pitting edema
Who might be at high risk for experiencing low serum magnesium levels?
a patient with cirrhosis of the liver r/t heavy alcohol consumption
A volume-depleted patient would present with which of the following diagnostic lab results?
BUN:creatine of 24:1
A fluid volume deficit can be caused by either dehydration or hypovolemia. What is the distinction between the two?
In hypovolemia only blood volume is low.
What effect does breathing faster have on arterial pH level?
Increases arterial pH
Which of the following is a factor affecting an increase in urine osmolality?
SIADH
Which of the following is a clinical manifestation of fluid volume excess (FVE)?
Shortness of breath Distended neck veins Crackles in the lung fields
What mechanism in the sodium potassium pump will move the excess body fluid?
active transport
What is one of the most important indications of an acid-base imbalance that is shown in an ABG?
bicarbonate
What is the major chemical regulator of plasma pH?
bicarbonate-carbonic acid buffer system
The nurse should be alert to which clinical manifestation associated with air embolism?
chest pain (angina)
Upon shift report, the nurse states the following laboratory values: pH, 7.44; PaCO2, 30mmHg; and HCO3, 21 mEq/L for a client with noted acid-base disturbances. Which acid-base imbalance do both nurses agree is the client's current state?
compensated respiratory alkalosis
Which findings indicate that a client has developed water intoxication secondary to treatment for DI?
confusion and seizures
An adult client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargy. The nurse reconciles the client's medication list and notes that salt tablets had been prescribed. What would the nurse do next?
consider sodium restriction with discontinuation of salt tablets
Which of the following is a clinical manifestation of fluid volume excess (FVE)?
crackles, jugular distention, SOB
What would you do as a nurse if you noticed your patient's IV was red, warm, swollen, and had localized pain?
d/c immediately
Which electrocardiogram changes will a patient with hyperkalemia display?
peaked T waves
The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process?
elevated BP
Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration?
elevated hematocrit
Hypokalemia can cause which symptom to occur?
excessive thirst
Which condition is a predisposing factor for respiratory alkalosis?
extreme anxiety
A low potassium usually results in what?
fatigue, cramps, weakness
While hypovolemia is to be avoided, there is also an accompanying danger for blood clots and urinary stones. What condition contributes to the possible development of these life-threatening events?
hemoconcentration
A client presents with anorexia, nausea and vomiting, deep bone pain, abdominal pain, confusion, and constipation. What are these symptoms indicative of?
hypercalcemia
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat what?
hyperkalemia
You should anticipate the administration of what fluid when treating a patient with FVD r/t CDiff-related diarrhea?
hypotonic or isotonic solutions
The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) and experiencing respiratory acidosis. The client asks what is making the acidotic state. The nurse is most correct to identify which result of the disease process that causes the fall in pH?
inability to blow off CO2
What effect does breathing faster have on arterial pH level?
increased arterial pH
Early signs of hypervolemia include what?
increased breathing effort and weight gain
hypertonic solution
increases the number of dissolved particles in the patient's blood, creating pressure for fluid in the tissues to shift to the capillaries and increase the blood volume
What do we know about evaluating skin turgor?
inelastic skin turgor is a normal part of aging
What does the nurse understand is the primary method by which fluid volume is regulated?
urine excretion
Which daily assessment data is necessary to determine changes in the client's hypervolemia status?
weight
Which pair of organs is responsible for regulatory processes and compensation?
lungs/kidneys
Which acid-base imbalance is most likely to occur with NG tube placement?
metabolic alkalosis
Hypokalemia is associated with this acid-base imbalance.
metaboliic alkalosis
Following a unilateral adrenalectomy, a nurse should assess for hyperkalemia as indicated by
muscle weakness
What process is primarily responsible for maintaining fluid balance along a concentration gradient?
osmosis
Hypertonic solution increases the number of dissolved particles in the patient's blood, creating pressure for fluid in the tissues to shift to the capillaries and increase the blood volume. What term(s) are associated with this process?
osmosis and osmolality
Oncotic pressure refers to the what?
osmotic pressure exerted by proteins
What is the term for the amount of hydrogen ions in a solution?
pH
What the term is for the amount of hydrogen ions in a solution?
pH
From what system would a sympathetic reaction to falling result in elevated HR, anxiety, thirst, and decreased urinary output
renin-angiotensin-aldosterone system
The nurse would expect to identify which acid-base disturbance in a patient experiencing depressed respirations?
respiratory acidosis
SOB is associated with this acid-base imbalance.
respiratory alkalosis
What role do the kidneys play in maintaining normal fluid balance?
selectively retaining needed substances and excreting waste
What clinical indication of hyperphosphatemia does the nurse assess in a patient?
tetany (involuntary contraction of muscles)
What occurs when fluid moves out of the intravascular space, but not into the intracellular space?
third spacing